I.
When fertility returns in lactation
period? The answer not exactly known:
The
exact time of the fertility returns
in postpartum period eludes the awareness of many women. The proper timing of
initiation their understanding and appreciation. Scientists too are equally in
dilemma so far as timing of initiation of contraceptives after childbirth is
therefore not within the orbit of their understanding and appreciation.
Scientist too are equally in dilemma so far as timing of initiation of
contraceptives after childbirth is concerned. This is simply because there is
no set chronology of events like ‘return
of menstruation’, ‘resumption of
sexual activity’ and ‘restoration of
ovulation’. All these variations are primarily due to changes noticed in
breast feeding practice and thus the possibility of further pregnancy. Return
of ‘fertility’, though primarily depend upon frequency and duration of
breastfeeding but there is gross individual and racial variation. It is all
these variations which have prompted the author to write a special chapter on
this issue i.e. timing of initiation of contraceptives in lactation period.
In spite of innumerable member of cross Country population breast studies
the speculation on return of ovulation and thus possibility of face pregnancy
in postpartum period still remains a matter of speculation :
We know that pregnancy to occur there
must be availability of egg released from ovary a process termed as
‘ovulation’. Sperms also must be available in female genital tract by the
process of sexual intercourse. The act of intercourse however can be easily
assessed by the couple themselves but the process o ovulation and thus presence
or absence of ovum can’t be assessed neither by the wife nor by the husband.
Because the process of ovulation do not cause any noticeable symptom or
distress so that no woman can say with certainity when she has ovulated and
thus in need of contraception unlike ‘menstruation’, ‘breast feeding’ and
‘sexual act’ unfortunately the process of ovulation remain asymptomatic.
Due
to lack of this scientific knowledge some women are unnecessarily initiating
contraceptive too early. There is still another group who are eager to use
contraceptive but they do so quite let in lactation period. This chapter
critically analyze the different factors that influence the return of
‘fertility’ in postpartum period. This chapter also highlights the time of
initiation of contraceptives at an appropriate time and taste of contraceptives
which can be safely used in lactation period. The magnitude and impact of
‘unintended pregnancy in lactational period have also been discussed briefly.
II.
Where we were? What the couple used
to do earlier in initiation of contraceptive?
At the present time of writing a
conclutions couple has three choices about timing the initiation of
contraceptive lactation period. Firstly, the couple consider initiation of
contraceptive whenever they resume sexual activity after childbirth. Logically
it is a good practice but, quite often the sexual activity resume after
childbirth time when many women are naturally infecund due to lack of
resumption of ovulation. Thus if initiation of sex is considered as the index of
commencing contraceptive there will be always a chance of initiation
contraceptives too early which is possibly a burden to the couple. As stated
earlier, unlike menstruation and ‘sexual act’ the act of ovulation can not be
perceived by the woman. Thus a woman remains unaware about resumption of
ovulation in postpartum period.
There is a second group of women
who start using contraceptives only when they discontinued breastfeeding : But this phylosopy is wrong and
unscientific because many woman do omlete after six month of childbirth
insitite of continued breastfeeding. There is a third group of couple who would
like to commence contraceptive whenever menstruation resumes in postpartum
period. This philosophy apparently sounds well but a doption of this method of
initiating contraceptive is also unscientific such policy may giverise to
unintended pregnancies because in many breastfeeding women ovulation precedes
visible event of menstruation. Thus scientifically speaking restoration of
menstruation also cannot be used as an index of initiation of contraception.
III.
What woman expects from Science ?
Most
couple would like to start contraceptive when ovulatin resumes and dislike
using contraceptive unnecessarily before resortion of ovulation. There is a
real taste of science in this belief. Thus return of ovulation as an indexx of
starting contraception though scientifically correct but the process of
ovulation can’t be gauged at the present state of knowledge.
No
cheap method for detection of resumption ovulation is available. It would have
been easier on the part of couple and scientists too if there have been a easy
ready made low cost but predictable monitoring method of assessing maturation
and release of eggs. Unfortunately whatever home monitoring tests for ovulation
exist that are too costly for planning contraceptive use. Till date the use of
these tests are limited to infertility treatment only.
No comments:
Post a Comment